Should our well-child care system be redesigned? A national survey of pediatricians
Should our well-child care system be redesigned? A national survey of pediatricians
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DOI：
10.1542/peds.2006-1425
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发表时间：
2006-11-01
期刊：
影响因子：
8
通讯作者：
Lantos, John
中科院分区：
文献类型：
--
作者：
Coker, Tumaini;Casalino, Lawrence P.;Lantos, John
目标。研究的目的是检查儿科医生对是否以及如何更好地照顾0-5岁儿童的看法。方法：通过邮寄调查对全国1000名普通儿科医生进行了调查，调查工具检查了儿科医生对我们目前的方式和提供良好儿童护理的理想方式的态度和行为。结果：60%(n=502)的符合条件的受试者回答了这项调查。几乎所有的受访者(97%)都认为美国目前的制度在提供良好的儿童保育方面非常优秀或很好。大多数儿科医生(85%-91%)报告说，他们目前是预期指导、发育筛查和心理社会筛查的主要提供者。然而，大多数(54%-60%)的人报告说，在最大限度地提高护理效果和效率的理想系统中，非内科医生将提供这些服务。更少的儿科医生(24%)报告说，理想情况下非内科医生应该提供体检。大多数受访者(79%-93%)表示，至少可以通过电话或电子邮件通信进行一些预见性指导、小型急性护理和慢性护理服务，55%的受访者表示至少应该在其他地点提供一些良好的托儿服务，如日托中心。在多变量分析中，对这些变化的支持广泛分布在不同个人和执业特征的儿科医生中。结论：尽管大多数儿科医生总体上对我们目前提供良好儿童护理的方式感到满意，但大多数人认为，减少对医生和面对面办公室访问的依赖的系统将是提供护理的更有效和更高效的方式。
OBJECTIVE. The goal was to examine pediatricians' views about whether and how well-child care for children 0 to 5 years of age should be changed.METHODS. A mail survey of a national random sample of 1000 general pediatricians was performed with a survey instrument that examined pediatricians' attitudes and behaviors toward our current way and an ideal way of providing well-child care. Results were analyzed for the following 3 major domains of change in well-child care: provider type, visit format, and visit location.RESULTS. Sixty percent (n = 502) of eligible subjects responded to the survey. Nearly all respondents (97%) rated the current US system as excellent or good in providing well-child care. Most pediatricians (85% - 91%) reported that they are currently the main providers of anticipatory guidance, developmental screening, and psychosocial screening. However, a majority (54% - 60%) reported that, in an ideal system that maximized the effectiveness and efficiency of care, nonphysicians would provide these services. Fewer pediatricians (24%) reported that ideally nonphysicians should provide the physical examination. The majority of respondents (79% - 93%) reported that at least some anticipatory guidance, minor acute care, and chronic care services could be conducted through telephone or e-mail communication, and 55% stated that at least some well-child care services should be provided in alternative locations, such as day care centers. In multivariate analysis, support for these changes was distributed widely across pediatricians with varying personal and practice characteristics.CONCLUSIONS. Although most pediatricians are generally satisfied with our current way of providing well-child care, a majority think that a system that is less reliant on physicians and face-to-face office visits would be a more effective and efficient way to provide care.